جستجوی مقالات مرتبط با کلیدواژه « mesenteric ischemia » در نشریات گروه « پزشکی »

Coronavirus disease 2019 (COVID-19) is a major health problem worldwide. Vascular thrombosis is increasingly observed in COVID-19 patients. This complication seems to be due to coagulopathy and endothelial damage. In this paper, we report a COVID-19 patient with superior mesenteric artery thrombosis and review of 27 COVID-19 cases with acute mesenteric ischemia (AMI).

A 59-years old man with confirmed COVID-19 readmitted to the hospital due to abdominal pain and diarrhea two days after discharge from the emergency department. He was diagnosed with acute mesenteric ischemia by abdominal CT scan with contrast. The patient underwent emergency laparotomy and the ischemic gangrenous bowel was resected. Unfortunately, the patient succumbed one month after the operation.

AMI is a life-threatening thrombotic event rarely seen in COVID-19 patients, so it is vital to diagnose it. Anticoagulant and anti-inflammatory prophylactic therapies might be useful in preventing AMI, especially in the patients with thrombosis risk factor. So, it is crucial to reduce its incidence in COVID-19 patients.

Novel coronavirus disease 2019 (COVID-19) as a potential health risk factor continues to spread throughout the world. Although common symptoms include headache and respiratory symptoms, some studies have suggested that COVID-19 may cause coagulation disorders and thrombolytic events, disrupt blood flow to the visceral organs, and cause some complications such as mesenteric ischemia. The authors reported four cases of acute mesenteric ischemia associated with COVID-19 confirmed in patients hospitalized in Imam Reza Hospital (a COVID-19 referral center in Mashhad University of Medical Sciences, Mashhad, Iran). The authors described the pathological findings that may be associated with this infection. The authors collected clinical data, imaging, microscopic, and operative findings of four patients with severe COVID-19 infection and evidence of intestinal necrosis. These four cases that all had severe COVID-19 pneumonia simultaneously showed intestinal necrosis during the infection process, indicating a relationship between coronavirus and mesenteric vascular events. Physicians should be aware of thrombosis symptoms in the digestive system in patients with severe COVID-19 disease.

 The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) causes severe respiratory infection. Gastrointestinal symptoms have been reported in up to 10% of patients.

 We here report a case of COVID-19-associated acute mesenteric ischemia in a patient presenting with fever and abdominal pain, deteriorating over a four-day period. The diagnosis was initially missed due to a low suspicion level. COVID-19 infection was confirmed by chest CT scan and RT-PCR. Then the patient underwent an emergency laparotomy showing segmental small bowel ischemia of about 2 meters (between the lower jejunum and upper ileum). Resection of the ischemic segment was performed by end-to-end anastomosis. He was then discharged from the hospital after recovering from COVID-19.

 The present case report highlights the importance of being vigilant about mesenteric ischemia symptoms in the patients with COVID-19, presenting with progressive abdominal pain for timely ordering appropriate diagnostic and therapeutic procedures.

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now a global threat. Various papers have addressed the pulmonary symptoms of this viral disease. Also, thrombotic complications have been highly prevalent among COVID-19 patients. Reports on rare presentations of COVID-19 can help fast diagnosis and management. In this study, a COVID-19 patient is presented who developed mesenteric ischemia.

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) presents clinical manifestations similar to the influenza, severe acute respiratory syndrome (SARS-CoV), and Middle East respiratory syndrome (MERS-CoV). However, in the course of the coronavirus disease 2019 (COVID-19), various pathological complications of high clinical significance have remained unknown. Impaired blood supply to the visceral vascular system can cause serious life-threatening acute damage. We report a case of extensive acute mesenteric ischemia associated with SARS-CoV-2 infection confirmed in a patient hospitalized in Amin Hospital – a COVID-19 referral center in Isfahan University of Medical Sciences, Isfahan, Iran. This case highlights the importance of paying attention to serious and less common or less known clinical manifestations other than fever, dry cough, dyspnea, and myalgia.

We have recently established an intestinal rehabilitation unit (IRU) in Abu Ali Sina transplantation center affiliated to Shiraz University of Medical Sciences, Iran. Our intestinal failure rehabilitation and transplant program aims to provide state-of-the-art care for adult patients with different degrees of intestinal insufficiency and failure. In the IRU, we aimed to design an algorithmic approach to patients with small bowel ischemia and short bowel syndrome (SBS) based on our institutional experience in our country and based on other pioneering studies from other regions of the world.

Mesenteric ischemia is a rare disease with a high rate of mortality because of the non-specific symptoms which lead to delay in diagnosis and intervention. The main symptom is abdominal pain, which has a broad list of differential diagnoses. This study introduces a 17-year-old girl who presents to the emergency department with severe abdominal pain and hematemesis. Further evaluations revealed thrombosis in the mesenteric vein which leads to ischemia and gangrene of the small intestine. Her past medical history and drug history were negative, except she was taking levonorgestrel and cyproterone acetate for a 5 months period. Since long-term treatment with oral contraceptive pills, counts as a risk factor for venous thrombosis, this case seems to be uncommon.

Acute mesenteric ischemia (IMA) is a vascular emergency with broad variability of clinical presentations and non-specific laboratory findings. Therefore, there is a significant need for reliable serological markers of ischemia. Various laboratory studies may be performed for suspected AMI, but in general, such studies will not establish the diagnosis.
In a prospective, non-interventional study, from October 2012 to October 2013, we investigated 70 patients with probable diagnosis of AMI. Blood samples were taken from patients and analyzed for complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), urea, creatinine (Cr), sodium (Na), potassium (K), D-dimer, lactate, amylase, PH, partial pressure of carbon dioxide (PCO2), and bicarbonate (HCO3). Finally the results were compared with AMI diagnosis confirmed by computed tomography (CT) angiography.
Seventy patients with acute severe abdominal pain were studied. Thirty-nine patients (55.7%) were male and 31 patients (44.3%) were female. The average age was 68.01 ± 14.67 (±SD). Based on CT-angiography results, 27 (38.6%) patients had AMI and 43 (61.4%) patients did not have AMI. Chi-squire test showed P values of 0.606 and 0.986 for relations between sex and risk factors with AMI correspondingly. One-sample Kolmogorov-Smirnov revealed white blood cell (WBC), hemoglobin (Hb), platelets (Plt), urea, Cr, Na, K, PCO2 and HCO3 as normally distributed parameters (P > 0.05). Moreover PT, PTT, INR, D-dimer, lactate, amylase, and PH were non-normally distributed (P We found a significant relation between increased serum lactate level and definitive AMI diagnosis. We recommend rising serum lactate as a finding in AMI.

Biochemical markers are important for the timely diagnosis and follow-up of ischemic events. Most of the markers have been previously studied in the context of cardiac ischemia. However, research on markers of non-cardiac events has been insufficient. Therefore, we investigated the relationship between troponin and myoglobin which are commonly used markers of cardiac ischemia, in non-cardiac ischemia. Forty-eight rats were equally divided into six groups. Group I was the control group. Group II was the sham group and received a simple laparotomy. The superior mesenteric artery was clamped in groups III and IV in order to create mesenteric ischemia. The left femoral artery was clamped in groups V and VI in order to create peripheral ischemia. Intracardiac blood samples were taken from all groups (during the 3rd hour of ischemia in groups III and V and the 6th hour of ischemia in group IV and VI) and troponin T and myoglobin levels were measured. Troponin and myoglobin levels were statistically similar in groups I and II. Moreover, increments were detected for troponin and myoglobin in ischemia groups according to group I and II. Furthermore, higher troponin Tlevels were detected after three hours of mesenteric ischemia and higher myoglobin values were observed after six hours of mesenteric ischemia (P<0.05). Troponin T and myoglobin are not specific for non-cardiac ischemia, and they may be useful for detecting other ischemic events.